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96 Cards in this Set
- Front
- Back
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Respiratory
Upper Respiratory Tract? |
nose, oropharynx, and larynx.
Through the nose is the preferred route for the breathing in of (air) oxygen. |
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Respiratory
Lower Respiratory Tract? |
trachea, main stem bronchi, lungs.
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Respiratory
The act of breathing requires continuous input from the ________ ________? |
nervous system (respiratory center)
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Respiratory
The respiratory center is located in the __________? |
in the Medulla which is located in the lower brain stem.
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Respiratory
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the control of breathing has both automatic and voluntary aspects.
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Respiratory
Automatic regulation controlled by chemoreceptors and lung receptors. |
chemoreceptors monitor blood levels of O2, Co2, pH, and adjust breathing accordingly.
lung receptors monitor the breathing pattern and lung function. |
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Respiratory
Voluntary regulation allows integration of breathing with eating, speaking, singing, etc. |
controlled and initiated through the motor and premotor cortex.
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Respiratory
2 types of chemoreceptors? |
Central and Peripheral
Central most important, are located near resp. center & are bathed in CSF, where the CO2 content of the blood regulates ventilation through its effect on the pH of the brain's extracellular fl. |
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Respiratory
Peripheral Chemoreceptors? |
located in the carotid and aortic bodies where they monitor the OXYGEN levels of the arterial blood. Exert their effects when PaO2 drops below * 60 mm Hg *
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Respiratory
main resp. stimulant for 'normal' functioning lungs and ABGs is ________? |
Carbon Dioxide, from the central chemoreceptors.
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Respiratory
main resp. stimulant for those with constantly elevated CO2 (such as with COPD) is ________? |
low oxygen (low level PaO2), such as occurs during a hypoxic state, from the peripheral chemoreceptors in carotid and aortic bodies.
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Respiratory
Lung receptors? 3 types? Stretch: |
stretch: located in smooth muscle of conducting airways. respond to changes in pressure in the airway walls. they establish breathing patterns by adjusting rate & tidal volume to accommodate changes in lung compliance & resistance.
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Respiratory
Lung receptors? 3 types? Irritant: |
irritant: located b/t airway epithelial cells. stimulated by noxious gases, cigs, dust, & cold air and leads to constriction and a pattern of rapid shallow breathing.
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Respiratory
Lung receptors? 3 types? juxtacapillary: |
juxtacapillary: located in alveolar walls. thought to sense lung congestion, may be responsible for rapid, shallow breathing that occurs with pulmonary edema, embolism, and pneumonia.
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Respiratory - Common Cold
What? |
viral infection of upper resp. tract
most frequent of all- most contagious 1st 3 d after symptoms, incubation time is 5 d. |
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Respiratory - Common Cold
Why? |
associated with a number of viruses-
rhino, parainfluenza, respiratory syncytial, corona, and adeno viruses- Rhinoviruses most common b/t age of 5 - 40. |
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Respiratory - Common Cold
How it presents? |
feeling dry & stuffy, excess nasal secretion & lacrimation; usually clear & watery, m&ms of URT red, swollen, & bathed in secretions; also sore throat, hoarseness, HA, malaise. In severe case: chills, fever, exhaustion.
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Respiratory - Common Cold
Treatment? |
is usually self limiting to about 7 days-
rest, fluids, and antipyretics- wash HANDS, HANDS, HANDS- & disinfect |
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Respiratory - Rhinosinusitis
What? |
inflammatory process involving one or more of the para-nasal sinuses, typically follows a viral URT or allergic reaction
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Respiratory - Rhinosinusitis
Why? |
conditions that obstruct the narrow ostia that drain the sinuses (ex, URT infection, allergic rhinitis, nasal polps)
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Respiratory - Rhinosinusitis
How it presents? |
face pain-HA-purulent nasal discharge-
decreased sense of smell-fever- can lead to ext. to sinus bones, infection of intracranial cavity, meningitis, brain abscess |
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Respiratory - Rhinosinusitis
Diagnostic? |
H & P, turbinate edema, nasal crusts, purulent nasal cavity, failure of transillumination of the maxillary sinuses, x ray
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Respiratory - Rhinosinusitis
Treatment? |
antibiotics, decongestants, mucolytics, saline nasal sprays (Nasonex 4 d max), steam inhalations, cool mist humidifier in winter
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Respiratory - Influenza - 'da flu'
What? |
Viral infection of upper and lower respiratory tract-
Causes 3 types on infection: 1. uncomplicated URI 2. viral followed by bacterial infec. 3. Viral pneumonia |
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Respiratory - Influenza - 'da flu'
3 types? |
Type A: account for most problems, can jump species and become more virulent 'swine influenza' 'avian influenza'
Type B & C can't jump, but do affect different species, and are way less common. |
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Respiratory - Influenza - 'da flu'
How? |
Incubation Time: 1-4 d (2 d avg)
Mode of transmit is aerosol (cough, sneeze), or direct contact. |
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Respiratory - Influenza - 'da flu'
How it presents? |
Rapid Onset!
Fever, chills, malaise- muscle ache, HA profuse water nasal discharge- nonproductive cough, sore throat- |
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Respiratory - Influenza - 'da flu'
Treatment? |
early recognition and tx w/ antiviral meds: Flumadine, Symmetrel-
prevent complications- limit infection to URT- fluid, rest, NO ASPIRIN in children- |
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Respiratory - Influenza - 'da flu'
Prevent- |
wash HANDS, HANDS, HANDS-
flu vaccine q year- is contraindicated in: person sick with a fever; impaired immune system; egg allergy; mercury allergy; hx of Guillain-Barre: Women > than 14 wk preg. OKAY |
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Respiratory - Pneumonia
What? |
an inflammatory process of the lung parenchyma (functional parts).
2 major types: a. community-acquired b. hospital-acquired |
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Respiratory - Pneumonia
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6th leading COD in US-
classified based on type (typical=bacterial & atypical=viral), distribution of infection, and acquired setting. |
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Respiratory - Pneumonia
How/Why? |
maybe primary or complication of another disease * ASPIRATION*
all persons susceptible ^ elderly- immobility is significant factor- |
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Respiratory - Pneumonia
How it presents? |
Rapidly rising Fever, Chills, Productive cough, Diaphoresis, Tachycardia, Tachypnea, Fatigue, Weakness
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Respiratory - Pneumonia
Treatment? |
vaccine, Pneumovax: definitely those who are immunocompromised
have underlying respiratory disorders, no spleen, taking corticosteroids |
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Respiratory - Pneumonia
What? |
an inflammatory process of the lung parenchyma (functional parts).
2 major types: a. community-acquired b. hospital-acquired |
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Respiratory - Pneumonia
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6th leading COD in US-
classified based on type (typical=bacterial & atypical=viral), distribution of infection, and acquired setting. |
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Respiratory - Pneumonia
How/Why? |
maybe primary or complication of another disease * ASPIRATION*
all persons susceptible ^ elderly- immobility is significant factor- |
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Respiratory - Pneumonia
How it presents? |
Rapidly rising Fever, Chills, Productive cough, Diaphoresis, Tachycardia, Tachypnea, Fatigue, Weakness
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Respiratory - Pneumonia
Treatment? |
vaccine, Pneumovax: definitely those who are immunocompromised
have underlying respiratory disorders, no spleen, taking corticosteroids, 65 and older, < than 2 not so much- |
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Respiratory - Pneumonia
Treatment? |
antibiotics, mucolytics, bronchodilators, supplement O2,
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Respiratory - Tuberculosis
What? |
a common and often deadly infectious disease caused by mycobacteria, in humans mainly Mycobacterium tuberculosis mainly attacks the lungs but can affect any organ.
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Respiratory - Tuberculosis
How? |
initial infection occurs within 2-10 weeks, inhaled dry droplet, may lie dormant for many years
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Respiratory - Tuberculosis
Risk Factors? |
Low socioeconomic/medically underserved, Advanced age, Chronic illness, Long-term care, DM, Malnourishment, Direct exposure to mycobacterium TB
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Respiratory - Tuberculosis
How it presents? |
Asymptomatic early, Nonproductive cough, Low-grade fever, Night sweats, Pleuritic chest pain, Wt loss, Anorexia, Fatigue and Malaise
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Respiratory - Tuberculosis
Nurse management? |
PPD- TB skin test (not indicative of active TB), Sputum is most definitive, PT in isolation with redirected room air, N95 or 'particulate' mask.
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Respiratory - Tuberculosis
Nurse management? Drugs? |
primary drugs are isoniazid (INH), rifampin, pyrazinamide, ethambutol, streptomycin. undergoes many mutations, so tends to acquire resistance to 1 drug treatments. *chemotherapy*
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Respiratory - Lung CA
What? |
leading cause of death of CA
mainly ages 50-75, Cigarettes related to 80-90% cases, Poor prognosis, 5-year survival rate is 14% |
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Respiratory - Lung CA
4 types? |
Small cell carcinoma (SCLC)
Squamous cell cancer (NSCLC) Adenocarcinoma (most common US) (NSCLC) Large cell carcinoma (NSCLC) |
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Respiratory - Lung CA
Small cell carcinomas (SCLC) is characterized by? |
distinctive cell type-small, round-
cells grow in clusters- linked to cig. smoke almost always- highly malignant, ^ infiltration, rare resectability, brain metastases common |
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Respiratory - Lung CA
non-small cell lung CA (NSCLC) are characterized by? |
squamous cell- ^ in men, smoking, early detection with cytology of sputum- Adenocarcinoma- most common US, women, & nonsmokers, poorer stage for stage prognosis
Large-cell- large polygonal cells, difficult to categorize, poor prognosis d/t early spread |
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Respiratory - Lung CA
Risk factors? |
-smoking
-Family hx of lung CA -Air pollution -Pre-existing pulmonary disease |
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Respiratory - Lung CA
How it presents? |
Chronic cough, rusty or purulent sputum- Hoarseness- Dysphagia
Pleural effusion- Pain- Fatigue Recurrent pneumonia or bronchitis- |
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Respiratory - Lung CA
Treatment? |
Radiation, Chemo, Bronchodilators, Pain meds, Antibiotics, Antipyretics, Antiemetics
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Respiratory - Pleuritis (pleurisy)
What? |
Inflammation of the pleura, or lining of the lung
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Respiratory - Pleuritis (pleurisy)
Why? |
Common during many infectious processes involving the lungs-
smoking- |
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Respiratory - Pleuritis (pleurisy)
How it presents? |
very painful to breathe, tidal volumes small with rapid breathing, pain is usually unilateral & tends to be localized lower lateral parts of chest,
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Respiratory - Pleural Effusion
What? |
an abnormal collection of fluids in the pleural cavity-
can be exudate, purulent drainage, blood |
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Respiratory - Pleural Effusion
Why? |
^ capillary pressure (CHF)
^ capillary permeability (inflamed) Decreased collodial osmotic pressure (hypoalbumine) ^ negative intrapleural space impaired lymphatic drainage- |
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Respiratory - Pleural Effusion
How it presents? |
hemothorax, fever, decrease lung expansion and volume, dull & flat to percuss, diminished breath sounds, dyspnea, pleuritic pain, mild hypoxemia
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Respiratory - Pleural Effusion
Treatment? |
Treatment directed at cause-
cxr, ct, Thoracentesis Maintain ventilation and perfusion, O2 sat. vitals. |
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Respiratory - Pneumothorax
What? |
Air in the pleural space
Prevents lung expansion and exchange of oxygen & carbon dioxide |
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Respiratory - Pneumothorax
Tension-Pneumothorax |
life-threatening condition that results from worsening of a simple pneumothorax. Air becomes trapped in the pleural cavity between the chest wall and the lung, and builds up, putting pressure on the lung, heart, & trachea
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Respiratory - Pneumothorax
Why? open or closed- |
Open penumothorax occurs when air enters pleural space through opening in chest wall. lung disease, spontaneous occurrence, liver/kidney disease, invasive procedures, mechanical vent.
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Respiratory - Pneumothorax
How it presents? |
pleuritic pain, dyspnea, tachypnea, use of accessory muscles, anxiety & apprehension, decreased/absent breath sounds, hypotension, tachycardic
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Respiratory - Pneumothorax
Treatment? |
small may resolve on their own-
large may need ICS needle or chest tube- CXR, monitor O2 sat, LOC, vitals- |
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Respiratory - Atelectasis
What? |
is a partial or total lung collapse and airlessness of lung tissues-
MOST common post-op complication as its a preventable complication of immobility- |
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Respiratory - Atelectasis
Why? |
post-op complication, immobility, inability to TCDB,
Pneumothorax, Pleural Effusion, Tumor, Loss of Pulmonary Surfactant |
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Respiratory - Atelectasis
Risks? |
COPD, Supine Position:
prolong Bed Rest, Mechan Vent. period of hypoventilation Inability to Breathe Deeply, Respiratory Depression Abdominal distention |
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Respiratory - Atelectasis
Treatment? |
treat underlying cause-
teach TCDB, chest PT, incentive spirometry, early ambulation post-op, |
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Respiratory - Atelectasis
How it presents? |
tachypnea, tachycardic, cyanosis, anxiety, decreased/absent breath sounds, low O2 sat, hypoxemia, etc.
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Respiratory - Asthma
What? |
chronic inflammatory disease of the airways. most common in children.
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Respiratory - Asthma
Characterized by? |
hyperresponsiveness, mucosal edema, bronchoconstriction, and excess edema
Extrinsic (external factors), Intrinsic (internal factors) Significant in COPD Dx based on client history May be intermittent or persistent |
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Respiratory - Asthma
Risks? |
Hereditary predisposition, allergic rhinitis, environmental irritants (dust, smoke), Hypersensitivity (pollen, bee stings, food, drugs, mold)
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Respiratory - Asthma
How it presents? |
Wheeze, cough, chest tightness/pain; exposure to cold, exposure to irritants; Frequent bouts of “bronchitis”, Waking up at night with coughing or wheezing, snoring, GERD complaints
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Respiratory - Asthma
Treatment? |
prevent exposure to irritating substances or environments-
use of bronchodilators, anti-inflammatory |
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Respiratory - Status Asthmaticus
What? |
an acute episode of bronchospasm that is severe. it is a life-threatening attack of asthma.
40-60 & children < than 2 more susceptible: 10% require ICU hypersensitivity to aspirin may precipitate |
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Respiratory - Status Asthmaticus
How? |
Upper/Lower Resp. Infections, environmental triggers, Ingestion of Aspirin or other NSAIDS, Cessation of Corticosteroids, Abuse of Aerosol Treatments, Poor Control or Undiagnosed Asthma
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Respiratory - Status Asthmaticus
How it presents? |
***Inaudible breath sounds with reduced wheezing***
Severe, prolonged dyspnea, Severe inspiratory and expiratory wheezing, Non-Productive cough, Hypertension, Orthopnea, Diminished breath sounds, |
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Chronic Obstructive Pulmonary Disease (COPD)
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Groups of several disease
*Chronic Asthma, Chronic Bronchitis, Emphysema Primary Cause: Smoking |
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COPD- Chronic Bronchitis
'blue bloaters' What? |
airway obstruction by inflammation of the bronchi caused by irritants or infection-
can be acute or chronic condition- |
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COPD- Chronic Bronchitis
'blue bloaters' Dx when? |
Dx when • Hypersecretion of mucus and chronic productive cough lasts for 3 months of the yr and having occurred for at least 2 consecutive years
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COPD- Chronic Bronchitis
'blue bloaters' Patho? |
irritants inhaled for prolonged time; recurrent inflammation leads to hypertrophy & hyperplasia of mucus glands, increased goblet cells, ciliary damage, lymphocytic infiltration, and fibrosis of bronchial walls
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COPD- Chronic Bronchitis
'blue bloaters' How it presents? |
Gray, white or yellow sputum, dyspnea, cyanosis, use of accessory muscles, tachypnea, cor pulmonale, wt gain, wheezing, ^ expiratory time, rhonchi, pulm hypertension
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COPD- Chronic Bronchitis
'blue bloaters' |
CXR will show hyperinflation, PFTs reveal ^ residual volume, decreased vital capacity & forced expiratory flow, ABGs decreased PaO2 and normal or increased PaCo2
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COPD- Chronic Bronchitis
'blue bloaters' Treatment? |
Avoidance of air pollutants, smoke cessation, bronchodilators, CPT, mechanical nebulizers, corticosteroids- (lowers immune)
O2, Pneumo vaccine! |
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COPD- Emphysema
'pink puffers' What? |
marked by airflow limitation, lack of elastic recoil in the lungs, and destruction of alveolar walls.
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COPD- Emphysema
'pink puffers' Why? |
results from tissue changes/destruction d/t recurrent pulmonary inflammation from smoking and/or recurrent infections-
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COPD- Emphysema
'pink puffers How? |
recurrent inflammation results in increased inflammatory cell infiltration and action-
these cells release protease that digest proteins, lung is normally protected by the antiprotease (antitrypsin) but it cant keep up so lung tissue destruction goes unchecked |
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COPD- Emphysema
'pink puffers Result of destruction? |
airflow limitation & resistance, decreased recoil in the lungs, large air spaces created so total lung capacity ^, residual volume ^ (air trapping) so hyperinflation of lung ensues, lungs become enlarged A/P 1:1
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COPD- Emphysema
'pink puffers How it presents? |
dyspnea, chronic cough, anorexia, malasie, *Barrel-chest*, breathing through pursed lips, decreased tactile fremitus and chest expansion, decreased breath sounds, reduced PaO2, ^ PaCO2
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COPD- Emphysema
'pink puffers Treatment? |
avoid smoking, use bronchodilators, adequate hydration, mucolytics, corticosteroids, sit PT up, low flow O2, teach pursed lip breathing, TCDB, incentive spirometry
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Acute Respiratory Distress Syndrome (ARDS)
What? |
a severe, life-threatening disorder of the lungs
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Acute Respiratory Distress Syndrome (ARDS)
Why? |
Trauma, anaphylaxis, aspiration of gastric contents, diffuse pneumonia, drug overdose or reaction, inhalation of noxious gases, near-drowning
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Acute Respiratory Distress Syndrome (ARDS)
How? |
1. injury reduces blood to lungs
2. alveolar capillary membrane becomes damaged; fluid shift into interstitial space 3. capillary permeability ^ proteins and fluids leak out 4. decreased blood flow and fluids reduce surfactant; alveoli collapse, impairing gas exchange 5. PaO2 & PaCO2 are low 6. edema worsens; inflammation leads to fibrosis |
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Acute Respiratory Distress Syndrome (ARDS)
Treatment? |
ABGs show respiratory acidosis, metabolic acidosis, and declining PaO2 despite O2 therapy. Correct cause; Humidified O2, mechanical vent. volume ventilation, PEEP
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Acute Respiratory Failure
leads to tissue hypoxia Acute deterioration in ABG values, with clinical deterioration, indicates ARF |
Life-threatening; lungs can’t maintain arterial O2 or eliminate carbon dioxide.
Causes: resp. tract infections, COPD, CNS depression, Airway irritants, metabolic or endocrine disorders |
